ASPS annual stats show that liposuction has become one of the most commonly performed plastic surgery procedures, with more than 202,000 procedures performed in 2012. "The evolution of liposuction has seen refinements in technique and improvement of patient safety-related standards of care," write Dr. Geo Nicolas Tabbal of University of Texas Southwestern Medical Center, Dallas, and colleagues.

Attention to Principles Yields 'Consistent and Safe' Results with LiposuctionLong-term experience has shown the importance of close attention to detail-from good communication between the doctor and patient, to the technical aspects of the procedure, to postoperative care and attention to a healthy lifestyle after liposuction. Dr. Tabbal and coauthors outline five principles for successful liposuction, focusing on the goals of patient safety and good outcomes.

Preoperative Evaluation and Planning. Successful liposuction starts with good patient selection. "Patients should be generally healthy and demonstrate a commitment to long-term lifestyle changes, including both healthy diet and exercise," the authors write. They highlight the need to ensure "appropriate and realistic" expectations-promoted by good communication between the surgeon and patient. Key elements of surgical planning are discussed, including the choice of suction-, ultrasound-, and power-assisted techniques.

Intraoperative Monitoring and Safety. Except for some limited procedures, liposuction is generally performed with general anesthesia. The anesthetist plays a critical role in monitoring the patient during surgery. Dr. Tabbal and colleagues outline principles of positioning to provide good access for the surgeon to perform liposuction while protecting patient safety.

Wetting Solutions and Fluid Status. Techniques using various "wetting solutions" have been developed to allow larger-volume liposuction to be performed safely and with good results. With the use of these techniques, close monitoring of the patient's fluid status is essential.

Body Contouring and Prevention of Complications. Dr. Tabbal and coauthors discuss key technical considerations in performing three-dimensional body contouring during liposuction. Immediate fat grafting-transferring some of the patient's own fat cells-can be performed as needed to correct any contour irregularities that develop during the procedure.

Postoperative Care and Outcomes Measurement. Patients should wear compression garments for the first two weeks after liposuction, and at night for a few weeks afterward. Routine steps are outlined to minimize complications, which can be broken down into "undesirable sequelae," causing cosmetic issues; and various types of medical/surgical complications, some of which resolve with time.

Studies have found that patients' rating of their cosmetic outcomes are the "pivotal determinant" of their satisfaction with liposuction; patients who are dissatisfied with their liposuction treatment are also those with the lowest opinion of their appearance. In particular, weight gain has direct negative effects on patients' perceptions of their appearance and satisfaction with the results of liposuction.

Recognizing that fact, Dr. Tabbal and coauthors re-emphasize the need for proper patient selection and patient-physician dialogue. They highlight the importance of "educating patients on postoperative lifestyle changes, including continued exercise and health eating, which are tenets of successful liposuction treatment."

Plastic and Reconstructive Surgery-Global Open® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.